Author: Jordan Metsky

Categories
Emotion Empathy General Law

Gratitude: A Good Recipe for Holiday Cheer

The “most wonderful time of the year” is often filled with stark contrasts. While glitz and opulence surround us, sorrow and despair seem to grow emboldened. Nowhere is this truer than in a big city, where poverty and privilege so closely intermingle. Minutes after I walked down Fifth Avenue, basking in the glow of the Christmas lights infinitely multiplied in the facets of glittering diamonds displayed on shop windows, I found myself peering down into a simple metal container full of school supplies. This school-in-a-box, provided by the United Nations Children’s Fund (Unicef), was on display as part of an exhibit called “Insecurities: Tracing Displacement and Shelter”. Insecurities represents one installation in the Citizens and Borders series organized by the Museum of Modern Art (MoMA) in New York City. The Citizens and Borders project aims to highlight experiences of migration, territory, and displacement[1]. Standing in front of this school-in-a-box, I thought of our medical school, replete with its high-tech anatomy lab, treadmill desks, and air conditioning system so powerful it sometimes forces us to use blankets in our lecture halls for warmth. I thought of my comfortable bed at home, and of the night table that stands next to it, teeming with books, and of the shelf above it filled with movies.

Once more, we find ourselves in the midst of the holiday season, awash with bright lights and commercial cheer. This year’s winter holidays occur on the heels of an extremely draining presidential election season that left over fifty percent of Americans feeling stressed and anxious.[2] Already this month, I have seen patients who have related somatic complaints to the election, cooking, and spending time with their extended family To add insult to inury, the commercialism of the season which suggests we ought to see the world through the rosy hues of a colored ornament can exacerbate feelings of stress and anxiety in those who are already overwhelmed and not feeling their healthiest.. As a caregiver, I realize that it is important for us all to be especially sensitive this year to patients who may be feeling a bit less than the usual holiday cheer.

Peering down into the school-in-a-box reminded me of how grateful I am for the many privileges in my life. Some of these privileges, like a loving and supportive family, or being born in a country with free speech and democratic elections, are pure happenstance. Others I have worked hard for, like the privilege of attending medical school and caring for patients. It is important, now more than ever, that we have gratitude for our privileges in life, and help our patients extend an outlook of gratitude in their own life.

Gratitude has11522685876_5d27ebdb25_o consistently been shown to have a positive impact on mental health. Dr. Martin E. P. Seligman, a psychologist at the University of Pennsylvania, asked study participants to write letters of gratitude to people in their lives whose important contributions had previously gone unacknowledged. He then quantified the impact of these letters on the study participants’ letter writers by providing them with a happiness score. Unsurprisingly, the mere act of writing the letter and expressing gratitude was found to boost each participant’s happiness score.[3] As physicians, we ought to support many outlets for creative expression, from yoga to painting, as ways to contribute to our patients’ well being, but we also need to consider gratitude as its own kind of healing salve. Whether we encourage our patients to write expressions of gratitude to special people in their lives, or just to reflect on the small blessings in their everyday lives, gratitude should have a place in our roster of medical advice. We cannot and should not strive to take away the things in our patients’ lives that cause them discomfort, anxiety, and sorrow, whether they be personal events or national political outcomes. Good medicine is not about making the world a more comfortable place, but rather, making our patients more comfortable within the world.

[1] https://www.moma.org/calendar/exhibitions/1653?locale=en

[2] http://www.npr.org/2016/11/06/500931825/how-to-deal-with-election-anxiety

[3] http://www.health.harvard.edu/newsletter_article/in-praise-of-gratitude

 

Photo credit: Timo Gufler

Categories
Empathy Technology

Robots: Not just for kids any more

Years ago, my brother and I shared a metal robot with moveable arms and legs. This plaything belonged to the same fantasy realm as Barbie dolls and Power Rangers, and the idea that it might one day be a colleague was not only unfathomable, it was laughable. Fast-forward two decades to the present day, and robots have a very real role in medical care. At present, hundreds of thousands of surgeries are performed each year using robotic technology[1]. This past June, two Belgian hospitals began employing robotic receptionists that can understand up to twenty languages[2]. In Japan, robots have been used to lift and transfer patients from their hospital beds[3].  And right here in America, Watson, the same robot that won Jeopardy in 2011, is being put through his medical residency in the University of North Carolina Lineberger Comprehensive Cancer Center[4]. Just a few months ago, Watson, who has never experienced the years of grueling drudgery to which we have subjected ourselves as medical students, correctly identified the cancer of a patient whose diagnosis had stumped physicians across the globe[5]. As humankind continues to create technologies with the potential to outsmart their creators, it’s hard not to wonder whether we, as doctors, may soon become obsolete.

While mulling over this very question, I saw a young patient who needed blood work. Upon finding out that she was being sent to the lab, the young girl was filled with sheer terror. After much crying, kicking, and screaming, her mother eventually managed to drag her down to the lab. After we had seen our next patient, the doctor with whom I was working decided to go down to the lab to check on our very petrified young patient. At that moment, I was reminded that our ability to care for people in the most trying times of their lives makes us as doctors unique from most other professionals. As doctors, we will have the privilege of making human connections with each of our patients. Robots can digest huge amounts of information, stay up to date on the most current medical practices, and make correct diagnoses in puzzling patient histories, but they will never eclipse physicians because they do not have a reliable set of ethics, nor do they have the shared human experience that underlies the doctor-patient relationship.

The prospect of artificial intelligence in medical practice may be heralded by some as a major scientific breakthrough, but it is important not to hyperbolize the role of robots on a medical team. Though the prospect of finding forms of artificial intelligence in your local hospital is becoming increasingly likely as time passes, many of us can only speculate what it would be like to work alongside a robotic colleague. No matter what, artificial intelligence should only be viewed as a physician aid, not a physician replacement. While it is true that forms of artificial intelligence may certainly help us with diagnoses and complex surgical procedures, these tasks are only one small part of the care that we as physicians have agreed to provide to our patients. The other part of this care is the genuine concern that we show to our patients. Robots may be more knowledgeable and more hardworking than some human doctors, but until a robot can sense human suffering, walk down to a lab, and hold the hand of a little girl who is scared senseless by the idea of having her blood drawn, they are still incapable of providing the most important medical service of all: empathy.

Featured image:
robot! by Crystal

Categories
Psychology Reflection

Reassessing Resilience

Recently, I had the opportunity to work with a young female patient whose healthcare history could rival that of an octogenarian in complexity. At the end of our 70-minute intake interview, the physician with whom I was working asked our patient a question that made my head snap up from my notes: “What are your hopes and dreams?”

What a simple question to ask, and yet, with my medical student mindset, medication interactions and pending test results were more prominent on my radar than ever considering this patient’s future goals. According to the CDC, half of all American adults live with a chronic health condition, and 25% of American adults live with two or more of these conditions[1]. We are living in an age of chronic disease, and this state of unwellness is never more apparent than when we see patients with healthcare records and medication lists thicker than a Tolstoy novel. With so many health issues to track in just a single patient, it can be a challenge to see the patient through the problem list.

After the physician asked his question, I thought about how easily a member of the healthcare team could fail to foster patient resilience. Resilience is defined as “the ability of systems to mount a robust response to unforeseen, unpredicted, and unexpected demands and to resume or even continue normal operations.” [2] Even for patients with multiple healthcare concerns, including those with multiple adverse childhood experiences (ACEs), it is not unreasonable to believe that resilience can act as a protective factor against those concerns. Asking this patient about her ambitions allowed us to learn about the person that existed outside of the hospital. Understanding that this patient had a plan for her life, and had some notions about how to manifest those plans into reality proved that despite her numerous medical concerns and previous history, the capacity for resiliency was still there. For the first time in that hour-plus interview, I thought about her health conditions as interruptions of her regular life, rather than letting her life be defined by her illnesses.

Most of the research about resilience can be found in psychology literature. The American Psychological Association created a guide called the Road to Resilience, which lists ten recommendations for developing and maintaining characteristics of resilience. These include maintaining relationships with friends and family members, as well as desire and ability for one to improve their life circumstances. [3] It would be appropriate to inquire about these characteristics while taking a patient history. Another tool that we can use to assess patient resilience is the Resilience Questionnaire created by psychologists Mark Rains and Kate McClinn of the Southern Kennebec, Maine Healthy Start program. [4]

There is still plenty of room for research on resilience in the medical literature, but we need not wait for this research to develop our own understanding of the importance of resilience in our care delivery. In the case of our patient with the convoluted medical history, we were not seeing a difficult, diseased, bedridden patient with several chronic illnesses. We were seeing an artist and future psychologist whose life had been set off course by a series of medical misfortunes. It is certainly easier to think of resilience in terms of our younger patients, and while resilience may seemingly be less applicable to certain groups of patients who cannot necessarily overcome their medical concerns, it is still appropriate to help patients set reasonable goals and maintain their support systems. Furthermore, it is always appropriate to understand our patients’ identities outside of their hospitalizations or medical concerns, and it may be helpful to use this personal information to inform our medical therapies.

As medical students, we are rarely able to follow patients over time, so it can be difficult to think of them beyond the confines of their hospital rooms. It is easy to relegate patient “bonding” to the nurses who spend countless hours with these patients. I think one of the most meaningful things we can do as students is to periodically pause to remind ourselves, and our patients, that their hospitalization is only a freckle on their identity as a whole person. At one point, all of our patients had hopes and dreams that likely never involved illness. Part of our delivery of patient care ought to be reflective of helping patients work toward these hopes and dreams, and to identify, and foster, resilience traits whenever possible.

References:

  1. http://www.cdc.gov/chronicdisease/overview/
  2. http://www.ahrq.gov/downloads/pub/advances2/vol3/Advances-Nemeth_116.pdf
  3. https://philosophy-of-cbt.com/tag/resilience/
  4. https://acestoohigh.com/got-your-ace-score/

Featured image:
Slope Point by Ben

Categories
Empathy

Properly Unprepared

It was late afternoon, and the current nursing shift would be relieved in less than ninety minutes. The feeling of impending Friday freedom was palpable on the floor of the intensive care unit. I was on my way to meet with my last patient of the week, who had been brought in for an unintentional drug overdose. My goal was to determine whether the overdose was truly accidental, and if she was a candidate for compulsory psychiatric hospitalization. I passed by a large bank of computers without stopping, and knocked on the patient’s door. When I walked in that room, all I knew was the patient’s name, her age, and the reason for her hospitalization. Other than those preliminary facts, she was a complete mystery to me. I spent fifty minutes with the patient, and had a relatively pleasant conversation. When I walked out of her room, I opened her medical chart for the first time.

Unfortunately, that day, the story that I received from the patient and the information that I got from her chart told two different stories. Numerous providers had noted that she was irresponsible with medications, and I got the sense from the chart that she only sought medical care to gain access to controlled substances. Now that I had established a good relationship with my patient, I would have to re-interview her in an attempt to reconcile the information I had seen in her chart with the picture she had painted for me in the moments prior. My Friday freedom would just have to wait.

I would not be surprised to find out that the ICU staff was laughing at me that day. After all, I ended up spending more than two hours with this patient when I could have conducted only one brief interview. Even though the majority of my first hour with the patient was pure confabulation, I viewed it as a valuable component of my assessment. That first hour represented my sole opportunity to get to know my patient without any bias. Had I looked at her chart before walking into the room, I unquestionably would have written her off as an irresponsible, drug-seeking troublemaker. I would have asked her pointed, perhaps accusatory questions about her behaviors, and worse, I would have known exactly when she was lying to me, further eroding any respect I may have had for this patient.

Electronic medical record systems help to facilitate the sequestration of large amounts of information about our patients with minimal effort, and it’s largely considered taboo to meet with patients without first researching their medical record.  The information physicians can learn from the medical record can be undoubtedly beneficial in many situations, but extensive chart reviews can also lure us into a false sense of security, allowing us to preconceive an identity for our patients before ever having met them.

Had I read my patient’s chart that afternoon, I am certain that I would have made judgments about her that would have influenced my interview. Instead, I learned about my patient by allowing her to tell her own story. I thought about the information she shared with me, and, perhaps more importantly, what she failed to tell me. Because the patient never discussed her well-documented mishandling and possible dependence on prescription medications, I felt confident in making an assessment that this patient had relatively poor insight about her problems.

Featured image:
hGraph: patient + clinician looking together by Juhan Sonin

Categories
Clinical Opinion Public Health

The Opiate Epidemic: A tragedy for patients is a warning to physicians

As student doctors, we are entering the medical field in the middle of a raging wildfire: an “opiate abuse epidemic.”[1] The media would have us believe that addicted patients are perpetuating the problem of opiate misuse and overuse, but opiate misuse and overuse might only be a symptom of a larger problem: a medical culture in which physicians fail to practice good prescribing habits.

Overprescription and subsequent overuse of opiates is undoubtedly further complicated by the ambiguous disease process of chronic pain, a topic which deserves its own time and attention. Questioning provider prescribing practices, however, may be the only path forward in making sure that the tragedy of this crisis does not escalate further. In my mind, there are several features that characterize ideal, quality prescribing habits. First, quality prescribing should place an emphasis on patient education about the drug being proposed. A patient should also be screened for the risk of developing any side effects. Included in this should be a review of any other medication that the patient is currently taking, and potential drug-drug interactions. If necessary, a pharmacist should be involved in this evaluation. Finally, a plan between the physician and the patient to manage care should be established. For medications known to be highly addictive, this might involve a phone call a week later, and a follow up in-office appointment to see how the patient is reacting to the prescribed drug. If at any point these benchmarks for safely prescribing a medication cannot be met, then the treatment choice should be reevaluated.

It was curious timing that in the middle of this epidemic, on May 5, Hawaii House Bill 1072 quietly died in the Hawaii state senate.[2] Bill 1072 “Relating to Prescriptive Authority for Certain Psychologists,” was meant to allow psychologists to have medication prescribing privileges in order to compensate for the Hawaiian physician shortage.[3] At first, I was relieved to read that the bill had not passed the Senate. As a future physician, it’s unsettling to imagine another profession encroaching on the special modalities that we have at our disposal to treat patients, such as our prescribing privileges. But then I had a second thought. If the average physician fails to exercise high-quality prescribing practices, then perhaps clinical psychologists, who by definition study human behavior, might actually make better opiate prescribers than the average physician. In general, psychologists spend time listening and learning about their patients’ history and behavior patterns, offer counseling education, and meet with their patients on a regular basis. This model of health care encompasses many of the aspects needed for ideal prescribing habits, as previously described.

You don’t need a medical degree to understand that opiates are powerful drugs that have many side effects and can lead to addiction.  What we don’t yet seem to understand, as a profession, is how to effectively communicate these risks, or evaluate the best patient candidates for the use of opiates. A 1992 study by Wilson et al. found that when physicians increased the time of their patient interactions by just 1.1 minutes, there was a statistically significant increase in the amount of health education that a doctor could incorporate into a standard visit.[4] While it’s difficult to get specific data about the average length of a typical doctor’s visit[5], a 2013 article from the New York Times suggests that the average new physician spends only eight minutes with each patient.[6] If you have ever participated in a standardized patient encounter as part of your medical school curriculum, you have undoubtedly experienced the struggle to perform a history, physical exam, and basic patient counseling in 14 minutes. When you take into account the level of patient screening and education that the prescription of opiates, or any narcotic, demands, it seems implausible that a doctor can satisfy the requirements necessary to safely discharge a patient with an opiate prescription in such a short span of time.

In response to the opiate crisis, the ultimate long-term goal for the medical community should be to better understand chronic pain, and devise alternative treatment modalities for this diagnosis. In the meantime, however, the medical community should view this unfortunate situation as a call to reevaluate the quality of our prescribing practices. Current and future doctors need to commit ourselves to being worthy of the privilege of the prescription pad, so that it remains a treatment tool and not a source of patient harm.

References:

  1. http://www.cnn.com/2016/05/11/health/sanjay-gupta-prescription-addiction-doctors-must-lead/index.html
  2. www.civilbeat.com/2016/05/2016-session-ac-for-schools-help-for-housing-and-homeless/#.VyzIubQqa3o.mailto
  3. http://capitol.hawaii.gov/measure_indiv.aspx?billtype=HB&billnumber=1072&year=2016
  4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1881485/
  5. http://www.ajmc.com/journals/issue/2014/2014-vol20-n10/the-duration-of-office-visits-in-the-united-states-1993-to-2010
  6. http://well.blogs.nytimes.com/2013/05/30/for-new-doctors-8-minutes-per-patient/

Featured image:
Medication by Gatis Gribusts

Categories
Clinical Reflection

No Time For Error

In November 1999, the Institute of Medicine released a study entitled “To Err is Human: Building a Safer Health System.” Within the first line of that study, a sobering statistic was revealed: between 44,000 and 98,000 hospital deaths each year are attributable to preventable medical errors.[1] We have been taught about the communication shortcomings that can easily occur between members of a medical team who may be stressed, sleep-deprived, rushed. Even though we have been warned about the potential dangers that can result from the use of abbreviations and imprecise communication, it took a recent misunderstanding for me to leave my Boards-bubble and comprehend, on a personal level, just how misleading certain abbreviations can be.

A few weeks ago, I sat down at my desk and began going over the first lecture of the day. This was 6:30 am:  pre-coffee, pre-sunlight, pre-hair combing. At the time, we were studying the gastrointestinal system. As I reviewed the first few slides of this lecture, I became very confused. I kept seeing the abbreviation ‘LES,’ and I really couldn’t figure out what it was referring to – you have my full permission to laugh at me right now; like I said, it was pre-coffee. As a born and raised East Coaster, LES means one thing and one thing only to me: the Lower East Side of Manhattan. If you are unfamiliar with New York City, please allow me to take a brief detour here to tell you a bit about the wonders of the Lower East Side (LES). The LES has a rich history, greatly influenced by the fact that many Eastern European immigrants settled into tenement housing in the area after coming through Ellis Island. When I think of the LES, I think about deli sandwiches that are too large  to fit through a human mandible, knishes, amazing donuts, and macaroni and cheese pancakes. I do not reflexively think about acid reflux, vomit, and esophageal cancer, although the association may make sense considering the indulgent foods just mentioned. As you might imagine, when I finally figured out that LES was intended to stand for ‘lower esophageal sphincter,’ it was a bit of a letdown. And since I couldn’t get the aforementioned amazing donuts out of my head, my whole morning was pretty much lost when I spent 45 minutes on the phone trying to coordinate a cross-country delivery of them to the West Coast.

Despite the ambiguity, and in my case, potential hilarity, of using abbreviations, one thing is clear: there is an abundance of statistics and data to back up the assertion that medical errors cost lives. Just run a Google search for ‘medical error abbreviation deaths’ or some variation thereof and you will see thousands of hits about the health hazard of medical miscommunication. It’s easy enough to find data  showing how detrimental some timesaving charting techniques can be. As newly-minted members of the medical profession, we have the responsibility to act as the new guard and to usher in safer communication and documentation practices. We can begin to advocate for better safety practices by trying to limit our use of abbreviations in our charting, and we can ask our professors to do to the same in their lectures and test questions. Though becoming a physician is a long and rigorous journey, we should never take shortcuts along the way that have the potential to put our patients at risk of harm.

Featured image:
Doctors Chart – Hospital Chart by wp paarz

References:

[1] Institute of Medicine. To Err is Human: Building a Safer Health System. November 1999. https://iom.nationalacademies.org/~/media/Files/Report%20Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf

Categories
Emotion General

A Caution Against the Extinction of Emotion

“Well, you know, I was recently diagnosed with cancer,” my friend said lightly in the middle of a spirited conversation about the merits of eating organic vegetables. She smiled as though she had just mentioned a factoid about organic kale, and not told me something earth-shattering. She continued eating her lunch while I sat there slack-jawed, trying to arrange myself. So consumed was I with the news of the diagnosis, I cannot recall a single other thing that we discussed during that lunch.

Throughout medical school, our professors have often told us to “get comfortable with being uncomfortable.” Diligent student that I am, I believed I had mastered discomfort. I believed that no matter how difficult the patient or awkward the situation, I could muster up some empathy and manage to make that prized human-to-human connection that separates the clinicians from the caretakers.

It’s an illusion to believe that we are comfortable with discomfort if we only ever experience discomfort as physicians. In this unique profession of ours, we are prepared to meet strife and pain on a regular basis. Whether we are delivering bad news or seeing a struggling patient, discomfort is no stranger to us. It is essential, however, that we recognize the power imbalance inherent in these situations. As physicians, we are the ones delivering the bad news or offering advice to our patients. As such, we must come from the position of strength. I have also detected the unspoken expectation that no matter what awaits us when go through the door to see a patient, we must remain unchanged when we come back out the other side. While we empathize with our patients and do our best to help them, ultimately, once we step out of the examining room, that bad test result or unfortunate lifestyle choice is the patient’s emotional burden to carry forward, not ours. In other words, our professional responsibilities call upon us to maintain that misfortune as ‘other.’

Even as a student, I’m already seeing how challenging it can be to disentangle my professional identity from my personal life. In my professional life, I have cultivated a sort of empathetic stoicism that allows me to connect with patients ‘in the moment,’ and then quickly wash my emotions off and redirect my focus toward whatever task comes next. It’s a survival tactic that I suspect many of us have deployed. In our personal (non-professional) relationships, however, our identities as children, siblings, lovers, and friends must come before our identities as doctors. Unfortunately, the more time we spend practicing in our professional roles, the more difficult it seems to transition from professional to personal. In personal relationships, we cannot always anticipate when we’re going to receive news, either good or bad, but when we do, we cannot expect to go through the door and come back out unchanged.

In our professional lives, we’re expected to be compassionate but composed. We’re taught to deliver bad news, perform motivational interviewing, and deal with difficult patients, but I wonder where the line is between beneficial sensitivity training and detrimental emotional taming. Before we walk into an exam room, we read through the patient’s chart so we know what to expect, and this allows us to create a sort of comfortable discomfort to protect ourselves. I would argue that this emotional fortitude is not beneficial to all aspects of our lives. Emotions are sloppy—something  that doctors cannot afford to be—but I worry that if we don’t let our feelings bleed through the lines, emotional composure could pave the way for an extinction of feeling. After having lunch with my friend, I had felt frustrated with myself for being so stunned and scared by her news. I didn’t have the emotional composure that I would have with a patient, but that’s the key difference—loved ones are not patients. It’s a testament to our most intimate relationships to express our genuine feelings however uncomfortable they may be. Perhaps, as physicians, we need to work even harder to stay in touch with these feelings so that we never lose our ability to access them.

Featured image:
Feeling. by Javi Sánchez de la viña

Categories
General Lifestyle Technology

Keyboards and Stethoscopes: A reflection on digital etiquette in medical school

February 26th marks the 47th anniversary of the landmark freedom of speech case, Tinker v. Des Moines. This case concerned a group of students who wished to wear black armbands to protest the Vietnam War. When their school banned the armbands to quash the protest, the students decided to sue, and the case made it to the United States Supreme Court. In the final ruling, Justice Abe Fortas wrote, “It can hardly be argued that either students or teachers shed their constitutional rights to freedom of speech or expression at the schoolhouse gate.” When writing his response, Justice Fortas probably didn’t imagine the digital age that we would be living in just half a century later.

Thanks to the power of the Internet, people can connect from thousands of miles away and ideas can go viral in mere seconds. The freedom of expression that the Internet affords us is practically limitless. The Internet can bring greater awareness to important humanitarian issues like ALS through the Ice Bucket Challenge, but its power as a terrorist recruitment tool can also be harnessed to spread chaos and destruction.

I wonder, as medical students, what our responsibilities are towards using social media responsibly, and how we balance these responsibilities without sacrificing our freedom of speech. In observing our class Facebook page and reflecting on my own bevy of social media faux pas, I have come up with the following five suggestions that I believe strike a balance between our professional responsibilities as medical students and our First Amendment rights.

  1. If something on Facebook offends you, have a face-to-face conversation with the person who posted the content. Avoid writing an angry response or a long rant, which can perpetuate further miscommunication. If a face-to-face conversation is not possible, give yourself a cooling off period before you respond.
  2. Never take down someone’s post without first talking to him or her about it. In our class, we’ve had a few situations where administrators of our group pages have taken down posts that they deem to be offensive or inappropriate. Conceivably, this was done to protect the integrity of the group and keep our Facebook page a “safe space”, but in reality, taking down someone’s post violates their freedom of speech and can make them feel unsafe. Before choosing the safety of the many over the safety of the few, talk to the person who posted questionable content and see if they will alter or possibly remove their post on their own.
  3. No babysitters! School administrators and faculty should not “babysit” class Facebook groups. A class Facebook page should be about fostering a sense of camaraderie amongst students, not about representing a school’s public identity. Therefore, the page should be private, and it should be the collective property of the students who chose to use it. Should disputes arise, they should be settled amongst students. Administrators should avoid getting involved in social media disputes unless they are directly asked to step in. Handling miscommunications and managing uncomfortable situations with our colleagues is important training for our professional careers.
  4. It’s okay to be a backstage comedian. Though this is likely my most controversial suggestion, I strongly believe that in our high-stress lives as students, and later as physicians, we benefit from being able to let off steam in a protected environment. A few months ago, we received a rather outrageous and somewhat distasteful lecture from some guest speakers. Not surprisingly, certain members of our class took to Facebook to share their “fond memories” of this unforgettable class. Somehow, the school administration was alerted to this content, and the students were asked to remove their posts. It’s only natural that from time to time, we’re going to find humor in something that happens in school or in the workplace. I think that it’s healthy to derive enjoyment and levity from these occurrences. In his writing, Immanuel Kant argues that laughter at an event is not a show of superiority, but rather an acknowledgement that the event differed from any reasonable expectations. Acknowledging the comedy of a situation is not at odds with our professional identities when it helps us to process and move on with overwhelming or uncomfortable events.
  5. Express yourself! I love when my classmates post articles that they find that I would have never otherwise discovered, or when a discussion from class spills over onto Facebook page. It makes me feel like I’m part of a community of people who value learning and exploration, and I have learned a lot from these posts.

Reach out to me on the MSPress Facebook page! I would love to hear your thoughts on Facebook and social media etiquette in medical school.

Featured image:
Der Blogger… by Dennis Skley

Categories
Emotion General Lifestyle

Thank you for being a patient: A reflection on gratitude and its place in medicine.

I was walking through Target a few days ago when I noticed a banner had been discarded in a pile of clearance items. “Give Thanks,” it read. Assuming that the banner was a Thanksgiving leftover, I quickly moved along to a different aisle. Later that day, I started thinking about that banner, and its lowly place in the clearance bin. Gratitude has become a seasonal commodity. From November to mid-December, we’re reminded to give thanks, be grateful, and celebrate others through food and gifts. Unfortunately, the half-off banner serves as a reminder that the notion of gratitude can become “out-of-season” as we turn the page on the calendar.

One of my personal rules for daily life is to live each and every day with a grateful heart. I think this idea comes from having practiced yoga for more than a decade, where gratitude is a foundational tenant. At the end of almost every yoga class I have ever attended, both teacher and students bow their heads and say, “‘Namaste.” Namaste is a Sanskrit word which, loosely translated, means ‘the goodness in me honors the goodness in you.’ For me, this sacrosanct moment at the end of class is what makes yoga different from any other activity I have engaged in. As the instructor thanks me for allowing him or her to share the practice of yoga, I can both thank the instructor, as well as take a moment to thank myself for taking the time to do something good for myself. In contrasting my own personal attitude of gratitude with the Hallmark-esque notion that gratitude is a seasonal commodity, I began to wonder what place gratitude might have in the practice of medicine.

In my brief time as a student doctor, I have witnessed patients struggling with complex challenges that I never even considered prior to medical school. It’s true that many patients will visit us when they have a stuffy nose or an itchy rash, but just as important are patients who see us when they are struggling to quit addictions, deal with a major life change, or manage their own healthcare on a limited budget. It is these patients, especially, with whom it is imperative that we as healthcare providers work with to build trusting relationships. I believe that the first step of building such a relationship is an expression of gratitude. I want to thank patients for being brave, for reaching out, and for asking to get help. I want to tell them how very grateful I am that they have respected themselves enough to value their health, and for trusting me, or one of my colleagues, to help them make very important and potentially challenging life changes. Essentially, I want to say Namaste.

As we leave behind the snow-dusted magic of the holiday season, we should not let gratitude melt away like a snowman. Gratitude should be a part of our daily lives and a cornerstone of our medical practice. It only takes a moment to let our patients know how thankful we are for being part of their journey to wellness, but I predict that the impact it has on our physician-patient relationships will be long lasting.

 

Featured image:
The Stethoscope by Alex Proimos

Categories
General Public Health Reflection

Are you listening? Using the doctor-patient relationship to curb community violence.

If you’ve paid attention to the news recently, you might share my concern that mass shootings are becoming a normalized part of American culture. According to data collected by the United Nations, America leads the developed world in firearm homicides.[1] As a college student in Washington, DC, social justice was an inextricable part of my education. I volunteered, protested, and campaigned for issues I felt strongly about. Assuming you weren’t a student in our nation’s capital, let me tell you that these are all pretty typical parts of the DC college experience. In fact, my zeal for progressivism in the arenas of health and wellness contributed to my desire to become a physician. Unfortunately, it wasn’t until two of my friends were murdered within six weeks of each other this summer that I felt compelled to take a closer look at how, as a medical student, I could better integrate my passion for social justice into my education and clinical practice.

As medical students, our education becomes our lifestyle. It’s demanding, consuming, and vigorous. My support system likes to remind me that I’m not Atlas and that I can’t hold the weight of the world on my shoulders. They tell me to keep my nose in a book and stay focused on my studies. It’s difficult for me to comply with these directives when I feel like I’m neglecting the part of myself that is aware of the world beyond medical school. It took this summer’s tragedies to remind me that even as a student doctor, I need to hold myself accountable for working to reduce social injustice, particularly community violence. What I’ve realized is that while my activism efforts may not reflect those I experienced as a college student, I can still make simple adjustments in my current practice to potentiate positive change.

Since this summer, one of the modifications I made, in an effort to merge my medical and activist identities, is to ask my patients to rate their stress on a scale of one to ten when I take their social history. On the surface, this might not seem like a significant exercise. After all, I’ve been asking my patients about their life stressors since I started school last year. What I realized is that while most people can easily spout off a list of things that make them feel strained (bills, student loans, family responsibilities, looming deadlines, etc.), it’s an entirely different exercise to ask patients to evaluate their stress from a holistic perspective. Though this practice correlates stress level to a numerical value, I have found that I can actually get a better qualitative picture of a patient’s mental and emotional wellbeing and self-awareness by using the one-to-ten stress scale. Perhaps by using this scale, we will be able to gain awareness of and provide support for struggling patients before they feel compelled to turn towards violence.

I encourage you to employ the one-to-ten stress scale into your history taking routine in the hope that it can open the door to bigger, more important conversations about wellness and lifestyle with our patients. Please feel free to let me know how the scale works for you. I look forward to spending the rest of my medical career advocating for those who are underserved by the medical community, but for now, I hope that having these conversations can be a first step in helping patients deal with problems before they resort to violence. In the weeks and months that have followed the deaths of my friends, I find myself thinking a lot about the people who committed the violent acts that claimed their lives. I wonder if they had medical professionals in their lives who they felt comfortable talking to, and I wonder what they would have said if we, the medical community, had been listening.

References:

  1.  Global Study on Homicide. (2011). United Nations Office on Drugs and Crime. https://www.unodc.org/documents/congress/background-information/Crime_Statistics/Global_Study_on_Homicide_2011.pdf

Featured image:
Brother by Fabrizio Rinaldi